PCOS can affect any woman of reproductive age

Thursday

May 29, 2014 at 6:27 PMMay 29, 2014 at 6:27 PM

By Dr. Jeff HershDaily News correspondent

Q: My 15-year-old had not had her period for a few months and was gaining weight, so I took her to see her doctor. She was diagnosed with polycystic ovary syndrome, even though there were no cysts seen on her ultrasound. Is this the wrong diagnosis?A: Polycystic ovary syndrome (PCOS) is a very common condition, affecting up to 10 percent of women of reproductive age; this is likely an underestimate, as many cases where the symptoms are not severe go undiagnosed. PCOS is the most common endocrine problem and the most common cause of infertility in women of reproductive age.Although the exact cause of PCOS is not known, the condition manifests as an elevated production of male hormones (androgens such as testosterone) in the patient’s ovaries (androgens are normally produced there, but in PCOS, the levels produced are abnormally high). There may be a genetic component to many cases of PCOS; it is inherited in an autosomal dominant fashion, so getting just one gene predisposing to PCOS from either parent is sufficient to inherit the condition. Even in patients who have inherited a gene for PCOS, the severity of symptoms is very variable with some women manifesting minimal or no symptoms.The hormonal imbalance from PCOS may cause anovulation (no egg is released during the menstrual cycle; this may manifest as infertility), irregular or loss of menstruation (possibly primary amenorrhea where the adolescent does not have her first period by age 15, or secondary amenorrhea which is not having a period for at least 3 months even though the young woman’s periods have started), hirsutism (unwanted male pattern hair growth in a woman), acne, weight gain, insulin resistance (which may lead to metabolic syndrome including high cholesterol, high blood pressure and other symptoms, or even type II diabetes) and/or other symptoms.PCOS is diagnosed by identifying:n infrequent, irregular or complete loss of ovulationn excess androgen, with or without polycystic ovariesn that other conditions that may cause the patient’s symptoms have been excluded.Evaluation for PCOS starts with a careful history and physical exam focused on menstrual problems, hirsutism, acne and other possible manifestations of excess androgens, then blood tests are done to confirm the androgen excess. In addition, testing to evaluate the woman’s ovulatory pattern, to look for insulin resistance and to determine lipid levels (which may be elevated as part of the metabolic syndrome) may be helpful.Finally, tests to evaluate other conditions such as thyroid dysfunction, Cushing’s syndrome, elevated prolactin, androgen secreting cancers, congenital adrenal hyperplasia and/or other conditions may be indicated in some patients. An ultrasound will usually be done to look for polycystic ovaries, but 10 to 30 percent of patients with PCOS do not have this finding; this is because the development of cysts is likely secondary to the elevated androgen levels as opposed to being a root cause of the condition.Treatment of PCOS is aimed at controlling the concerning manifestations in the individual patient. Isolated hirsutism may be treated with hair removal techniques. Acne, insulin resistance, metabolic syndrome and diabetes will be treated as they would be in any other patient. Menstrual issues may be treated with birth control pills. Infertility may require hormonal treatments to restore ovulation; other infertility treatments may be indicated. Some patients may require medications to block the excess androgens.Overall, women with PCOS have an increased risk of developing metabolic syndrome and type II diabetes; the complications of these conditions, such as cardiovascular conditions, can occur as they would in other patients with these conditions. Women with PCOS also have an increased risk of developing endometrial cancer and depression.Female adolescents with symptoms suggestive of PCOS such as menstrual problems, hirsutism and/or acne not responding to usual therapies should be evaluated for PCOS. As this condition is very common in all women of childbearing age, PCOS should be considered for these reasons as well as in women who develop metabolic syndrome or type II diabetes. First degree female relatives of women diagnosed with PCOS should speak with their healthcare provider to see if they should be screened for this condition as well as conditions associated with it such as metabolic syndrome and diabetes.Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.